Student Application
2021/ 2022
Please note the following application requirements:
1. All sections of this application MUST be completed 2. A recent photo of the child
3. A copy of the child’s immunization record
4. A copy of the child’s birth certificate / passport 5. $100 registration fee (non-refundable)
6. $100 seat fee (non-refundable) **accident insurance included 7. A signed parent agreement form (attached)
8. A completed medical examination report –both pages (attached)
*** Applications will NOT be accepted unless they are returned completed with ALL of the items listed above.
Child’s name:
_________________________________________________ Sex:Birthday: __________________________________________________ Present age: ________________
Month / day / year
Name of the person the child lives with: ____________________________________________________
Mother’s name:
______________________________________________________________ P.O. Box: __________________________________ Home telephone: ____________________________ Street Address: ________________________________________________________________________ Place of employment: _________________________ Email address: _____________________________ Work telephone: _________________________________ Cell phone: ____________________________Father’s name:
______________________________________________________________ P.O. Box: __________________________________ Home telephone: ____________________________ Street Address: ________________________________________________________________________ Place of employment: _________________________ Email address: _____________________________ Work telephone: _________________________________ Cell phone: ____________________________Name of alternative contact:
_________________________________________ Relationship to child: ___________________________________ Home telephone: _________________ Place of employment: ___________________________________________________________________ Work telephone: ________________________________ Cell phone: _____________________________ *** Please list the name of persons authorized by the parents to pick up the childfrom school. Your child will not be released to anyone other than those on this list unless we receive direct permission from you.
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Photo of Child
P.O. Box SS-19006
Ph. 393-1879
Cell 816-5729
For Office Use Only Date admitted: __________ Admitted to grade: _______ Registration paid: [ ] Seat fee paid: [ ] One-time fee paid.: [ ]
Male [ ] Female [ ]
Permission slip
I hereby give permission for my child _______________________________ to participate in activities which may occur off the DaySpring academy campus such as field trips and practice for school shows. I give
permission for DaySpring Academy to take my child on field trips for the 2021/ 2022 academic school year. I understand that I will be notified one week prior to the field trip and I reserve the right to decline my child’s attendance. I also give permission for my child to participate in indoor and outdoor activities at Dayspring academy. I am aware of, and assume all risks and hazards associated with activities while at school including transportation to and from field trips, playing on the playground and in the classrooms and do hereby waive, release and agree to hold harmless DaySpring and its staff volunteers and sponsors for any claims arising out of injury to my child or property damage that might occur. DaySpring Academy has permission to take my child to a physician / hospital to receive emergency treatment during the 2021/ 2022 school year. I understand that the school will contact me as to the location of the emergency treatment. Also I agree that any photographs taken by DaySpring Academy may be used for advertisement purposes on brochures and other literature distributed by DaySpring and on its website.
Parent’s signature: __________________________________ Date: __________________________
Email communication
DaySpring will send all letters announcements and other communication from the school to you through the email. Please provide the names and e-mail addresses of those parents and guardians who should receive
announcements from the school.
*** At least one email address must accompany ALL Applications
PLEASE PRINT NEATLY & CLEARLY
_________________________________ ________________________________________________
Name Email Address
_________________________________ ________________________________________________
Name Email Address
_________________________________ ________________________________________________
Name Email Address
_________________________________ ________________________________________________
Name Email Address
_________________________________ ________________________________________________
Name Email Address
It is VERY important that parents check their email inboxes
EVERYDAY. DaySpring sends ALL updates, notifications, letters,
and important school announcements by email.
2021/2022
Child Care Agreement
The following agreement is made between:
DaySpring Academy - Pyfrom Rd. (Bar 20 Corner) Nassau, Bahamas &
Parent’s name: ___________________________________________________
Address: __________________________ Ph. _____________________
For the provision of education for:
Child’s name: ____________________________________________________ The terms of the agreement are as follows:
Days & hours of operation: Monday to Friday 7:30am to 3pm
FEES: Term Tuition $1100: *please refer to the “tiered” fee description
Fee Due dates: Friday, July 30th, 2021 Monday, December 6st , 2021 Monday, March 14st, 2022
Fees are due and are to be paid by the TERM directly to the bank in advance according to the payment schedule (above).
** ALL fees paid to DaySpring are non-refundable & non-transferable.
The Parent agrees to abide by all of the policies in the parent hand book and school brochure. The parents should supply these items: A nap mat & a towel for naptime, uniforms,
extra snacks [& lunch if not purchased from the school], an extra change of clothing, classroom supplies listed in the parent handbook.
The school agrees to inform parents, in writing, of increases in fees, changes in policy, & unscheduled center closings that are not already on the school calendar. Notification will be given by the parent for vacation periods or extended absentee days during the school year.
The School fee is payable whether the child does or does not attend School. There will be NO DISCOUNTS or REFUNDS of fees for vacations, sickness or holidays or if a child is absent or removed from the school. DaySpring is not obligated to hold open a child’s seat after 20
unpaid absentee days by the child.
_______________________ _______________________ _____________
(Signature of Parent) (Signature of Director) (date)
Fees which are not paid by the due date are subject to a late fee of $60.
Parents may choose to make a financial agreement at the school if they are not able to pay the fees according to the term fee schedule.
Financial arrangements MUST be requested BEFORE THE FEE DUE DATE!
Annual Academic Supply Fee: $390 (Toddler - K3)
$450 (K4) $500 (K5)
2021 / 2022
Medical Examination
IMMUNIZATION RECORD MUST BE ATTACHED
Child’s Name: ___________________________________ Age: _______ Sex:
Date of Birth: ____________________________ Telephone: _______________________
Mother’s name: ________________________ Father’s Name: _____________________
This section must be completed by a physician:
PHYSICAL EXAMINATION
Height ________ Weight ________
Please describes the child’s physical condition / health history: __________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Does the child have any allergies? _________________________________________________________ Does the child use any medications to control Asthma or an Asthmatic cough or wheezing?
_____________________________________________________________________________________ Does the child have any behavioral / developmental conditions, learning delays or sickness?
_____________________________________________________________________________________ _____________________________________________________________________________________ Describe the child’s behavior: Plays well with others [ ] Shy or withdrawn [ ] Fights/ hits others [ ] _____________________________________________________________________________________ Do you consider this child fit to take part in activities at a school? ________________________________ _____________________________________________________________________________________
Signature of Physician __________________________________ Date: ___________________________ Print Physician’s Name: _____________________________________ Phone: _____________________ Address: ___________________________________________________________________________
**BE SURE TO COMPLETE BOTH SIDES OF THIS FORM
This physical examination must be completed by your child’s doctor or a medical clinic once a year. Please have ALL sections completed, stamped and submitted with the application.
Male [ ] Female [ ]
2021 / 2022
Behavioral Checklist
Child’s Name: _____________________________________________ Age: ___________
The following statements may apply to this patient. If the statement applies to this child answer 'YES' and, if not, answer 'NO'. PLEASE answer every item.
1. This child engages in flapping hands, spinning in circles, walking on toes.
YES NO
2. This child lines up toys and other objects.
YES NO
3. This child has lost skills, such as speech skills, that he/she was able to perform before.
YES NO
4. This child repeats or 'echoes' what he/she has just heard from other people.
YES NO
5. Child's speech is delayed and he/she does not communicate by gesturing (pointing).
YES NO
6. Parents complain of severe behavioral tantrums.
YES NO
7. Parents complain that this child does not respond to his / her name being called.
YES NO
8. This child's facial expressions do not change much.
YES NO
9. This child does not seem to feel physical pain that most children would.
YES NO
10. Parents note that this child engages mostly in solitary play.
YES NO
11. Making eye contact with people is very difficult for this child.
YES NO
12. Even minor changes in schedules or plans cause this child to have outbursts.
YES NO
13. Loud noises really bother this child.
YES NO
14. This child eats a very limited number of foods.
YES NO
15. This child repeats certain phrases over and over, such as repeating commercials or
favorite movie scripts. YES NO
16. During meal times, this child refuses to eat or has severe tantrums.
YES NO
17. This child will eat only foods with certain textures (e.g., only crunchy foods).
YES NO
18. Parents have been advised to have this child screened for autism spectrum disorder.
YES NO
19. There is a family history of autism (e.g., a parent, grandparent, sibling, uncle, aunt).
YES NO
20. This child has a diagnosis of Autism / Pervasive Developmental Disorder.
YES NO
retrieved in part from: https://www.special-learning.com/checklist/questions
Signature of Physician __________________________________ Date: ___________________________
This checklist must be completed by your child’s doctor or a medical clinic once a year. Please have ALL sections
